Management of Urinary Tract Infections in Direct to Consumer Telemedicine

Abstract

BACKGROUND: Urinary tract infections (UTI) are a common reason for seeking care via direct to consumer (DTC) telemedicine, yet patterns of care, including antibiotic prescribing, have not been reported. OBJECTIVE: To describe management of UTI in a large nationwide DTC telemedicine platform. DESIGN: Cross-sectional observational study. PARTICIPANTS: Patients seeking care for or diagnosed with UTI via DTC telemedicine between July 2016 and July 2018. MAIN MEASURES: Patient measures included age, sex, geographic region, satisfaction with care, and patientreported call reason. High-risk patients were defined as males, patients over 65 years, or those diagnosed with pyelonephritis. Physician measures included specialty and geographic region. Antibiotic prescription was assessed overall and by antibiotic type. Variation in antibiotic prescriptions was assessed by patient and physician factors, including geographic region of both parties. KEY RESULTS: Of the 20,600 patients diagnosed with a UTI during the study period, 96% were female. Most (84%) stated their call reason was a UTI. Overall, 94% of UTI patients received an antibiotic; 56% got nitrofurantoin, 29% got trimethoprim-sulfamethoxazole, and 10% got a quinolone. Receipt of an antibiotic was associated with higher satisfaction with care (p < 0.001). While nitrofurantoin was the most common antibiotic for all physician regions, antibiotic type varied by physician region. Of the 6% of the study population defined as high risk, 69% received an antibiotic: 72% of males, 91% of women over 65, and 21% of patients diagnosed with pyelonephritis. CONCLUSIONS: Management of UTI via DTC telemedicine appears to be appropriate for average-risk patients, and most are able to self-diagnose. Most patients received guideline-concordant care, but over half of high-risk patients received antibiotics. DTC telemedicine offers convenient, low-cost care that is generally appropriate. Efforts should be made to ensure high-risk patients get proper follow-up.

Diagnosis and Management of UTI in Primary Care Settings—A Qualitative Study to Inform a Diagnostic Quick Reference Tool for Women Under 65 Years

“…Small studies evaluating the use of protocol-led telephone consultations to manage UTIs show general success; however, a significant proportion of patients in these studies required physical examination, referral, or the need for urine culture because of the risk of complications [ 25 , 26 ]. A recent study in the United States of America (USA) assessed clinicians’ management of 20,600 telemedicine patients who were diagnosed with a UTI [ 27 ]. The study did not provide any guidance for clinicians regarding diagnosis and management of UTIs.…”

Digitale Innovation in der Medizin – die COVID-19-Pandemie als Akzelerator von „digital health“

“…Auch in der Urologie finden digitale Technologien vermehrt Anwendung. So konnte gezeigt werden, dass die Behandlung von Harnwegsinfekten über Telemedizinplattformen möglich ist [ 21 ]. Eine breitere Anwendung zeigt sich jedoch für nicht ganz so zeitkritische Erkrankungen, sodass gerade im Bereich erektiler Dysfunktion durch Telemedizin v. a. in den USA Start-ups viele Patienten erreichen [ 22 ].…”

A consulta telefónica em sete passos

“…São exemplos casos em que apenas seja necessária a emissão de documentos e certificados médicos que não exijam a avaliação em presença física ou a renovação da prescrição de terapêutica medicamentosa, acompanhamento e suporte dos utentes com quadros depressivos, utentes que se encontrem a realizar cessação tabágica ou situações de doença aguda, como infeções do trato urinário em mulheres, e que, pela sua frequência e simplicidade de tratamento, podem ser orientadas com segurança pelo telefone. 5 Outro exemplo de uso de consultas telefónicas são os sistemas de triagem telefónica. Não sendo esta uma atividade habitualmente afeta às competências da medicina geral e familiar, pode ser um complemento importante numa altura em que é necessário limitar o fluxo de utentes no interior das instalações da unidade de saúde, ajudando assim a esclarecer antecipadamente, à chegada do utente, a prioridade clínica de atendimento ou a necessidade de redirecionar para outros circuitos de atendimento aqueles utentes que se dirigiam à sua unidade de saúde por outras questões que não por doença aguda.…”